Murtas R, et al. - In Italy, the first diagnosis of COVID-19 was confirmed on 20 February 2020 in the Lombardy region. As the population exhibited a rapid spread of the infection, it was suggested that in Europe, and specifically in Italy, the virus had already been present in the last months of 2019. Researchers here tested the hypothesis on the early presence of the virus in Italy by appraising data on trends of access to emergency departments (EDs) of individuals with a diagnosis of pneumonia during the 2015–2020 period. A total of 105,651 pneumonia-related ED visits were observed during the studied period. Relative to the expected, a lower occurrence was noted in January 2020, while the province of Lodi had initiation of an excess of pneumonia visits on February 21, 2020, and almost 10 days later, this was observed in the remaining territory of the ATS of Milan. Overall, the excess peaked on March 17, 2020 and ended in May 2020, the administrative end of the Italian lockdown. Findings indicate the feasibility of an early warning system based on routinely obtained administrative data and suggest this as a low-cost strategy to monitor the actual situation of the virus spread both at local and national levels.